If additional space is needed please attach a separate page to this form. OSCA (04-19) PR530 1 of 3 475.082 RSMo IN THE JUDICIAL CIRCUIT, , COUNTY, MISSOURI Probate Division PROBATE Case Number: In the Estate of , Incapacitated Person Guardian222s Annual Status Report 226 Incapacitated Person I/We, guardian/co-guardians of the above named ward submit the following information as required pursuant to the provisions of section 475.082, RSMo. 1. State the present address of the ward: 2. State your present address: Please check here if your address has changed since filing your last report. 3. If ward does not reside with you, during the last year, how many times have you seen the ward? 4. State the nature and description of your contact with the ward: 5. What was the date you last saw the ward? 6. State the nature and description of your visits with the ward: 7. State any activities the ward has participated in during the past 12 months: . 8. To what extent has the ward participated in decision-making? . 9. Is the ward currently institutionalized? Yes No Place of institutionalization: Person in charge of institution/home: 10. If institutionalized: As guardian/co-guardians have you received a copy of the treatment or habilitation plan? Yes No If yes, what is the date of such plan: American LegalNet, Inc. www.FormsWorkFlow.com If additional space is needed please attach a separate page to this form. OSCA (04-19) PR530 2 of 3 475.082 RSMo 11. Do you agree with the provisions? Yes No If not, explain what you disagree with: 12. When was the ward last seen by a physician or other professional? 13. What was the purpose of the visit? 14. State the current mental and physical condition of the ward: 15. State any major changes in the condition of the ward: 16. If so, explain, state your observations: 17. In your opinion, should this guardianship be continued? Yes No If no, why not? 18. If you have been appointed limited guardian, should your powers be increased? Yes No If so, in what respects and why? 19. Pursuant to section 475.082.9 RSMo. Provide a summarized plan of care for the ward. An individual support plan or treatment plan for the ward for the coming year may be submitted in lieu of this requirement. American LegalNet, Inc. www.FormsWorkFlow.com If additional space is needed please attach a separate page to this form. OSCA (04-19) PR530 3 of 3 475.082 RSMo . The undersigned swears that the answers set forth above are true and correct to the best knowledge and belief of the undersigned, subject to the penalties for making a false affidavit or declaration. Return to: Signed this day of , 20 Signature of Guardian/Co-Guardians Printed Name of Guardian/Co-Guardians Street Address City State Zip Code Telephone Number Email Address FOR COURT USE ONLY Reviewed: Date Judge American LegalNet, Inc. www.FormsWorkFlow.com